The Assembly met at 10.30 am (Mr Speaker in the Chair).
Members observed two minutes’ silence.

North/South Ministerial Council: Food Safety and Health

Mr Speaker: I have received notice from the Minister of Health, Social Services and Public Safety that she wishes to make a statement on the meeting of the North/ South Ministerial Council in its food safety and health sectoral format, held on 27 February 2002 in Dublin.

Ms Bairbre de Brún: Go raibh maith agat, a Cheann Comhairle. Ba mhaith liom tuairisc a thabhairt don Tionól faoin Chomhairle Aireachta Thuaidh/Theas a tháinig le chéile mar chruinniú earnáileach i mBaile Átha Cliath Dé Céadaoin 27 Feabhra 2002. Bhí gnóthaí a bhain le cur chun cinn shábháilteacht bia agus le comhoibriú ar cheisteanna sláinte faoi chaibidil ag an chruinniú.
I ndiaidh domh féin agus don Uasal James Leslie, Aire sóisearach in Oifig an Chéad-Aire agus an LeasChéad-Aire, bheith ainmnithe ag an Chéad-Aire agus ag an LeasChéad- Aire, d’freastail muid ar an Chomhairle a tháinig le chéile den cheathrú huair mar chruinniú den Earnáil Sábháilteachta Bia agus den Earnáil Sláinte. Bhí an tUasal Micheál Martin, an tAire a bhfuil cúram na Roinne Sláinte agus Leanaí air, agus a chomhghleacaí an Dr Thomas Moffatt, Aire Stáit a bhfuil cúram Sábháilteachta Bia agus Daoine Scothaosta air, ag feidhmiú ar son Rialtas na hÉireann.
Tá an ráiteas seo, a cheadaigh an tUasal James Leslie, á thabhairt ar a shon chomh maith.
Fuair an Chomhairle tuarascáil chuimsitheach ar an dul chun cinn i riarachán agus in obair an Bhoird um Chur Chun Cinn Sábháilteachta Bia.
Thug an Chomhairle dá haire dul chun cinn an bhoird agus é ag ullmhú plean ilbhliantúil trí bliana a bheas á chur faoi bhráid na Comhairle lena cheadú ag an chéad chruinniú eile i mí an Mheithimh, agus fosta ábhar thuarascáil bhliantúil agus cuntais an Bhoird um Chur Chun Cinn Sábháilteachta Bia don bhliain 1999-2000. Thug an Chomhairle dá haire fosta an dul chun cinn i gcuid réimsí eile, lena n-áirítear naisc idir saotharlanna a fhorbairt agus comhaltachtaí taighde a dhámhachtain. Cheadaigh an Chomhairle go gceapfaí beirt bhall bhreise ar an Choiste Chomhairleach Eolaíochta agus go nglacfaí leis na scálaí leasaithe tuarastail don chéad ghrúpa de 20 ball foirne a fostaíodh.
Chuir feidhmeannaigh ón Roinn Sláinte agus Leanaí taispeántas i láthair na Comhairle faoi fhorbairt na straitéis sláinte ‘Cáilíocht agus Cothoime’, a seoladh i mí na Samhna seo caite.
Fuair an Chomhairle tuarascálacha breise faoin dul chun cinn i ngach ceann de na cúig réimse comhoibrithe san earnáil sláinte. I measc na dtosaíochtaí a aimsíodh le haghaidh comhoibriú bhí seirbhísí taismí agus éigeandála, pleanáil le haghaidh olléigeandálaí, comhoibriú ar threalamh ardteicneolaíochta, taighde ar ailse, agus cur chun cinn sláinte.
Sa réimse seirbhísí taismí agus éigeandálaí, thacaigh an Chomhairle leis an chomhoibriú leanúnach trasteorann sna seirbhísí ospidéal atá á mhaoirsiú ag Grúpa na Seirbhísí Ospidéal Réigiúnach Thuaidh/Theas. Thug an Chomhairle dá haire fosta an comhoibriú ar conas seirbhísí trasphlandála orgán a fhorbairt ar bhonn uile-oileáin; tá sé beartaithe ag na feidhmeannaigh faoi seach eolas a mhalartú le linn dóibh seirbhísí duán a athbhreithniú sa Tuaisceart agus sa Deisceart.
Sa réimse pleanáil le haghaidh olléigeandálaí thacaigh an Chomhairle leis an dul chun cinn go dtí seo i bhforbairt clár de chúrsaí pleanála trasteorann le haghaidh éigeandálaí, freagairtí comhpháirteacha ar thaismí bóthair agus an dul chun cinn i gcuid nithe eile. Thacaigh an Chomhairle fosta leis na réimsí breise oibre a d’aimsigh meithleacha a bhí ag obair ar nithe eile ar nós prótacail chumarsáide.
Maidir le comhoibriú i ngnóthaí ardteicneolaíochta, cheadaigh an Chomhairle moladh go mbunófaí scéim iniúchta fisice radaiteiripe Thuaidh/Theas le comhoibriú a chur chun cinn idir ionaid radaiteiripe sa Tuaisceart agus sa Deisceart. Thug an Chomhairle dá haire fosta go bhfuiltear ag forbairt creata ar bhonn leanúnach le measúnú a dhéanamh ar fheidhmiú tomagrafaíochta astaithe posatrón ar bhonn uile-oileáin agus go bhfuil ceardlann/seimineár faoi na forbairtí is déanaí san ardteicneolaíocht á heagrú ag an ghrúpa comhpháirteach um theicneolaíocht sláinte.
Thug an Chomhairle dá haire go bhfuiltear ag leanúint den chomhoibriú sa taighde ar ailse mar chuid den chomhaontú trípháirteach a chuimsíonn an Institiúid Náisiúnta Ailse sna Stáit Aontaithe Mheiriceá agus na Ranna Sláinte sa Tuaisceart agus sa Deisceart. Thug an Chomhairle dá haire go háirithe an obair atá ar siúl ag grúpa na gclárlann comhthaighde agus é ag leagan amach tosaíochtaí le haghaidh taighde comhoibritheach agus ag caighdeánú bhailiú sonraí.
I dtaca le cur chun cinn sláinte, thug an Chomhairle dá haire an dul chun cinn go dtí seo i dtionscnaimh éagsúla a ceapadh leis an tsláinte a chur chun cinn. Orthu sin bhí meastóireacht ar an fheachtas faoi aigéad fólach, tionscnaimh in éadan chaitheamh tobac, tionscnamh faoi chothú, agus tionscnamh uile-oileáin le sláinte san áit oibre a fhorbairt.
D’aontaigh an Chomhairle go mbeadh an chéad chruinniú eile san fhoirm earnáileach seo aici sa Tuaisceart i mí an Mheithimh 2002.
D’aontaigh an Chomhairle ar théacs na teachtaireachta a eisíodh i ndiaidh an chruinnithe. Cuireadh cóip den teachtaireacht i Leabharlann an Tionóil.
I want to report to the Assembly on the meeting of the North/South Ministerial Council held in sectoral format in Dublin on Wednesday 27 February 2002. The meeting considered matters relating to food safety promotion and co-operation on health issues.
Following nomination by the First Minister and the Deputy First Minister, Mr James Leslie, junior Minister in the Office of the First Minister and the Deputy First Minister, and I attended the fourth meeting of the Council in the food safety and health sectors. Mr Micheál Martin, the Minister responsible for the Department of Health and Children, and his colleague Dr Thomas Moffatt, Minister of State with responsibility for food safety and older people in the Department, represented the Irish Government. This statement has been approved by Mr James Leslie and is also made on his behalf.
The Council received a comprehensive progress report on the administration and work of the Food Safety Promotion Board (FSPB). The Council noted the board’s progress on the preparation of a three-year multi-annual plan, which will be submitted for approval to the next Council meeting in June, and the FSPB’s annual report and accounts for 1999-2000.
The Council also noted progress in several other areas, including the development of laboratory linkages and the awarding of research fellowships. It approved the appointment of an additional two members to the scientific advisory committee and revised remuneration scales for the initial tranche of 20 staff.
The Council received a presentation from officials in the Department of Health and Children on the development of the health strategy, ‘Quality and Fairness – A Health System for You’, which was launched last November.
The Council received further reports on progress made in each of the five areas of co-operation in health. The priorities identified for co-operation include accident and emergency services, planning for major emergencies, high-technology equipment, cancer research and health promotion.
With regard to accident and emergency services, the Council endorsed the continuing cross-border hospital co-operation overseen by the North/South regional hospital services group. It also noted co-operation on assessing the potential for the development of organ transplantation services on an all-Ireland basis, and that respective officials plan to exchange information during the reviews of renal services, North and South.
The Council endorsed the progress to date on the development of a programme of cross-border emergency planning courses, joint responses to road traffic accidents and several other matters. It also endorsed further areas of work identified by the working groups on issues such as communication protocols.
In relation to co-operation on high technology, it approved a proposal to establish a North/South radiotherapy physics audit scheme to develop collaboration between the respective radiotherapy centres. It also noted that a framework for assessing the operation of positron emission tomography on an all-island basis is still being developed and that a joint workshop seminar on emerging high- technology development is being organised by the joint health technology group.
The Council noted ongoing co-operation on cancer research as part of the tripartite agreement, which includes the National Cancer Institute in the USA and the Health Departments, North and South. In particular, it also noted the work carried out by the joint research registries group on the setting out of priorities for collaborative research and the standardisation of data collection.
With regard to health promotion, the Council noted progress to date on a range of health promotion initiatives, including the evaluation of the folic acid campaign, anti-smoking initiatives, nutrition and the development of an all-island workplace health initiative.
The Council agreed that its next meeting in these sectoral formats would take place in the North in June 2002. It agreed the text of the communiqué issued following the meeting, and a copy of that has been placed in the Library.

Dr Joe Hendron: I welcome the Minister’s positive statement. I was particularly interested to hear about the co-operation on accident and emergency and cancer services. The Committee’s recent report on cancer services in Northern Ireland highlighted the need for further investment. The co-operation on cancer research under the tripartite agreement with Dublin, Belfast and Washington is important for attracting the best cancer specialists and maintaining the world-leading cancer research currently being undertaken in Belfast. The co-operation between the ambulance services is welcome, and the Assembly will have a debate on the Ambulance Service later today.
What is the framework for assessing the operation of positron emission tomography (PET) on an all-Ireland basis? The Minister played a significant role in getting high technology into the Royal Victoria Hospital, although it will take some time to establish.

Ms Bairbre de Brún: I thank the Member for his welcome to the statement, which strikes a positive note on ongoing work. The framework for assessing the operation of PET technology on an all-island basis is in development. People are familiar with CAT (computer-assisted testing) and MRI (magnetic resonance imaging) scans. PET technology is a major new development in medical imaging, and I want to see everyone benefiting from advances in modern technology, particularly imaging. I am content that the joint health technology group should examine the feasibility of PET technology. The development of PET clinical scanning services is a highly appropriate area for North/South co-operation.

Dr Esmond Birnie: Strand two of the Belfast Agreement speaks of
"the adoption of common policies, in areas where there is a mutual cross-border and all-island benefit".
Can the Minister tell the House what precise mutual benefit there is in the development of an all-island workplace health initiative? It is not clear to me what that would be.

Ms Bairbre de Brún: Given that the Member’s Colleague Sir Reg Empey expressed his willingness to have an all- island initiative, he will be able to give the Member even more detail on the matter than I can.
With regard to health promotion, it has been found that considerable savings can be made in economies of scale in ventures such as the folic acid public awareness campaign and other television campaigns. Rather than reinventing the wheel in two different parts of the island, we can co-operate by using work that has already been developed in one area and, therefore, share the cost. One area bears the cost of developing the awareness campaigns, and the other contributes to, or pays for, the cost of television advertising. That has been useful. In progressing such work, some people may be further forward than others. That allows us to learn about, and share, best practice. All those aspects will be progressed in the discussions.
In addition, Members will be aware that consideration is being given to the appointment of dedicated programme managers for the Health Promotion Agency in the North and the Health Promotion Unit in the South. That will progress the work programme on an all-island basis. The work being done here by the ministerial group on public health, and the work being undertaken by the Department of Enterprise, Trade and Investment on the occupational health forum, will feed into the considerations on the work being undertaken on workplace health on an all-island basis.

Ms Sue Ramsey: Go raibh maith agat, a Cheann Comhairle. I too welcome the Minister’s statement. I wish to return to a point made by the Chairperson of the Committee for Health, Social Services and Public Safety. Given that cancer services were debated in the House last week, and that today the situation facing the Ambulance Service will be debated, can the Minister tell the House how those two areas of co-operation are being developed? In addition, can the Minister update the House on the validation of qualifications for health professionals on the island, which was also the subject of a debate in the House?

Ms Bairbre de Brún: If I do not answer all the Member’s questions now, I will write to her.
With regard to cancer services, the Department has established links with the National Cancer Institute in the United States and the Department of Health and Children in Dublin to create a cancer consortium. The North/South Ministerial Council allows for ministerial oversight of the work that is being progressed through those arrangements. The arrangements afford world-class links to our research community, and the enthusiastic involvement of the National Cancer Institute is in part a response to the quality of the research that is already being carried out here. Through the consortium, the research and development office here has secured two jointly funded three-year epidemiology fellowships, which are linked to the Belfast and Southern cancer registries.
The close co-operation and collaboration of the registries will, for the first time, make data available on the incidence of cancer throughout the island of Ireland. The consortium is also fostering an exchange programme among the three partners, as well as a major clinical trials initiative. That will enable cancer patients throughout the island of Ireland to participate in clinical trials. The consortium also allows us to take part in international conferences. One such conference will take place in the Royal Victoria Hospital in October 2002.
The feasibility study on the all-island helicopter service has been jointly commissioned, and a report is expected in June 2002.
Work is also being undertaken on the response to road traffic accidents. That will include work on ambulance and hospital services in border areas to ensure maximum co-operation to the benefit of all patients in those areas.
I am afraid I have forgotten the final point.

Mr Kieran McCarthy: I welcome co-operation in all areas of food safety and health. The Minister may have already answered my question about accident and emergency services. Members have mentioned the provision of an all-Ireland air ambulance, and the Minister has just mentioned it.
Will the excellent co-operation and businesslike manner in which the North/South meetings have taken place be able to continue, given the unnecessary, offensive and stupid remarks about our cross-border neighbours made by David Trimble at the weekend?

Mr Speaker: I am not clear that the second question related much to the Minister’s statement, but the Minister may wish to respond to the first question.

Ms Bairbre de Brún: With regard to the first point, the advertisement inviting tenders for a feasibility study on the costs and benefits of an all-Ireland helicopter emergency medical service (HEMS) was placed in national newspapers, North and South, during the week ending 26 January 2002. Fifteen tenders have been received, and they will be evaluated. The aim is for the evaluation exercise to start in mid-March, and it will be completed by the end of June 2002.
The North/South Ministerial Council has overcome barriers and difficulties to date, and I am sure that it will continue to do so.

Health and Personal Social Services Bill: Second Stage

Ms Bairbre de Brún: Go raibh maith agat, a Cheann Comhairle. Molaim go dtugtar a Dhara Céim don Bhille Sláinte agus Seirbhísí Pearsanta Sóisialta.
Tá dhá aidhm ag an Bhille measardha goirid seo. Ar an chéad dul síos, soláthróidh sé cúram altranais saor in aisce i ngach cás tríd chúram altranais saor in aisce a chur ar fáil dóibh sin atá i dtithe altranais. Tríd an bheart thábhachtach seo, má cheadaíonn an Tionól é, is ar bhealach níos cothroime a mhaoineofar cúram fadtéarma feasta. Ó mhí Dheireadh Fómhair 2002 caithfear le cónaitheoirí thithe altranais ar an dóigh chéanna leo sin atá faoi chúram ina dtithe féin. Soláthrófar seirbhísí sláinte de réir riachtanais agus beidh siad saor in aisce nuair a bheas siad á soláthar; ní bheidh siad ag brath ar acmhainneacht chun íoctha.
Sa dara háit, tríd an Bhille seo beifear in ann comhlacht áitiúil nua a bhunú le tacú le forás gairmiúil an altranais agus an chnáimhseachais anseo — an Chomhairle Chleachtais agus Oideachais don Altranas agus don Chnáimhseachas. Imríonn corradh le 20,000 altra cláraithe agus tuairim is 5,000 ball foirne tacaíochta ról barrthábhachtach agus iad ag soláthar cúram sláinte agus sóisialta do dhaoine anseo. Oibríonn siad i gcuid mhór rólanna agus suíomh, lena n-áirítear na hearnálacha deonacha agus neamhspleácha. Is é aidhm na gairme, a oibríonn i dtimpeallacht chúram sláinte atá ag síorathrú, cúram ardcháilíochta a sholáthar go seasta; cúram a fhorbraítear agus a thugtar cothrom chun dáta ar mhaithe le hothair agus le húsáideoirí seirbhíse. Leis seo a bhaint amach, caithfidh na struchtúir a bheith ann le tacú leis an ghairm, go háirithe sna heochair-réimsí seo leanas: dea-chleachtas, oideachas leanúnach agus foghlaim saoil, agus scoth feidhmiúcháin.
I beg to move
That the Second Stage of the Health and Personal Social Services Bill (NIA 6/01) be agreed.
The aim of this short Bill is twofold. First, it will provide for nursing care to be free in all settings by extending free nursing care to people in nursing homes. This important step will, with the Assembly’s consent, make the funding of long-term care fairer.
From October 2002, nursing home residents will be treated in the same way as those who are cared for in their own homes. Any nursing care that they require will be provided according to need and free at the point of delivery, not on the basis of ability to pay.
Secondly, the Bill will enable the establishment of a new local body — the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) — to support the professional development of nursing and midwifery. Over 20,000 registered nurses and an estimated 5,000 support staff play a vital role in the delivery of health and social care to people here. They work in a wide variety of roles and care settings, including the voluntary and independent sectors. The aim of the profession, working in a constantly changing healthcare environment, is to strive to provide consistent, high-quality care that is updated and developed for the benefit of patients and service users. To achieve this goal, it is essential to have structures in place that support the profession, particularly in the key areas of best practice, continuing education and lifelong learning, and excellence in performance.
In the debate on care for the elderly on 27 February 2001, I provided an overview of how England, Wales and Scotland had separately responded to the report of the Royal Commission on Long Term Care for the Elderly, and I gave an indication of my intentions in this regard. More recently, in the debate on 21 January 2002 on care in the community, I was able to report progress on a range of significant initiatives that I have taken over the past year. I remarked on the interim findings of the community care review, on work undertaken by my Department on carers, and on the imminent introduction of legislation to help support carers better.
I also anticipated the legislation that would be needed to transfer residents with income support preserved rights to care management by health and personal social services in April 2002, together with the resources to fund their care. Furthermore, next month I will introduce a three- month disregard on the value of a resident’s former home when he or she permanently enters a care home. I referred to this proposal in the debate on 27 February 2001. These changes to the charging rules for residential and nursing home care are evidence of my commitment to making long-term care for older people more responsive to individual circumstances and fairer for anyone who needs continuing help and support from health and personal social services.
Health and social services were given priority in the Budget statement of Monday 3 December 2001 on the Executive’s revised allocation proposals for 2002-03. This will enable the Department of Health, Social Services and Public Safety to tackle some of the current serious problems in the community and hospital sectors. Additional funding will be allocated to community care in the next financial year. In particular, £4·5 million will be provided for the introduction of free nursing care from October 2002, subject to the successful passage of the Bill.
It is estimated that there are approximately 2,000 residents currently paying the full cost, or most of the cost, of nursing home care. Those residents will benefit initially from the introduction of free nursing care. In order to qualify, residents will be required to have an appropriate assessment of their nursing care needs. The assessment process will be fair and easy to understand, and will involve the minimum of bureaucracy.
I asked the chief nursing officer to set up a group to advise me on an appropriate assessment process. This group of health professionals is involved in the development of an assessment tool, which will be ready by October 2002. The development process will include the preparation of associated guidance for, and the training of, nurse assessors to carry out assessments.
With regard to the measures required to provide free nursing care, the Bill will provide that the cost of time spent by a registered nurse in giving nursing care to residents of care homes will not be subject to charges for that care. Nursing care, for this purpose, is tightly defined as
"any services provided by a [registered] nurse … and involving —
(a) the provision of care, or
(b) the planning, supervision or delegation of the provision of care,
other than services which … do not need to be provided by a nurse so registered".
Therefore, from next October the cost of nursing care will be removed from the nursing home residents means test. The means test will then apply only to personal care costs and accommodation costs.
When Members resolved, at the end of the debate on care for the elderly on 27 February 2001, that the Executive should implement the recommendations of the Royal Commission on Long Term Care for the Elderly in full, they laid particular emphasis on the provision of free personal care.
I brought the Assembly’s resolution to the attention of the Executive on 3 May 2001. The Executive decided that an interdepartmental group should be established to examine the costs and implications of introducing free personal care here, drawing on the findings of the Scottish care development group. That interdepartmental group has been established, and its work is continuing. It is to report its findings to the Executive by the end of June 2002. The Executive will then consider if free personal care is affordable and if it should be implemented here.
I now turn to the proposed creation of the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC). Although individual organisations that deliver healthcare will support the development of their own nursing and midwifery staff, the creation of the new body will facilitate a much needed mechanism to develop consistency in the standards for achieving best practice, education and performance in nursing and midwifery. The new local body will also be able to support the work of the new four-country nursing and midwifery regulatory body — the Nursing and Midwifery Council — and will work locally on its behalf.
In addition, NIPEC will work alongside other local professional bodies to take forward multi-professional initiatives. In the development of the proposals for the establishment of NIPEC, a consultation paper was issued in August 2000 to a wide range of individuals, groups and organisations. Responses to the consultation, and subsequent meetings held with a range of stakeholders, indicated broad support for the proposals, particularly from the profession locally.
The establishment of the new body is an important step forward for the largest group of staff within health and social services. NIPEC will make a significant contribution to the development of nursing and midwifery, ultimately improving the quality of care provided for patients in hospitals and for service users in the community.
The Bill provides for a body corporate to be known as the Northern Ireland Practice and Education Council for Nursing and Midwifery, which shall have the duty to promote high standards of practice among nurses and midwives and in their education and training. It shall also promote the professional development of nurses and midwives. A schedule to the Bill provides for the proper governance and control of the new body.
Members will have points to raise, and I will try to answer as many as I can when winding up the debate. If I cannot respond to a particular matter today, I will write to the Member concerned.

Dr Joe Hendron: I welcome the introduction of the Health and Personal Social Services Bill. The Bill has two provisions, the first of which covers free nursing care, as the Minister stated. The other provision covers the establishment of the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC).
We have learnt that the Bill will provide for free nursing care for elderly people who live in nursing homes. The measure will cost approximately £9 million each year. The introduction of the measure has been deferred to the end of October 2002 due to lack of money in the Department’s budget allocation.
Currently the cost of nursing care for residents of a nursing home is included in the cost of their place in that home. If they are treated as residents of a nursing home, they may have to pay for their care. If the community nursing service treats them in their own home, or if they are treated in hospital, their care will be supplied free. That raises the question of equity of treatment, an aspect that the Minister has sought to address in the Bill. Residents of nursing homes who are in need of care and their families will welcome the revision.
The Committee for Health, Social Services and Public Safety will wish to explore the provision during its deliberations in the Committee Stage. Members will consider how it compares with similar action being taken in England, Scotland and Wales.
The other provision contained in the Bill establishes NIPEC. I welcome any measure that supports the effective professional development of nurses, midwives and health visitors, and improves the quality of care provided to patients by those professionals.
However, I am concerned that the proposal will create a new non-departmental public body in addition to the Nursing and Midwifery Council, due to come into existence in April. Members of the Committee for Health, Social Services and Public Safety will be interested to hear from the Department on the rationale for the new body. The Committee looks forward to considering the provisions of the Bill during the Committee Stage.

Mr Paul Berry: I will try to be as brief as possible — even briefer than the Chairperson of the Committee for Health, Social Services and Public Safety.
I welcome the Bill. I also welcome the opportunity that the Committee will have to discuss it in greater detail. However, I have one or two concerns about the issues, which I hope will be addressed.
Although every Member of the Assembly welcomes free nursing care, there were concerns some months ago regarding homes in England. Some of them were abusing free nursing care and were taking part of the money. It was not being properly distributed and was not, therefore, going directly to the people who needed it. Although I am not suggesting that that would happen in homes in Northern Ireland, I have some concerns. What action does the Department intend to take to ensure that that problem does not arise here?
Free nursing care for the elderly is welcome. However, there are major concerns that nursing homes are grossly underfunded. I am aware that an extra £3·5 million is being provided for nursing homes in this year’s Budget. However, that must run alongside free nursing care. It is all right to provide free nursing care, but if nursing homes across the Province are closing, that is a matter of grave concern. What is the Department’s long-term strategy for dealing with the gross underfunding of nursing homes? I welcome the Bill, and I look forward to examining it closely in the Committee.

Ms Sue Ramsey: Go raibh maith agat, a Cheann Comhairle. Like other Members, I will also attempt to be brief. I welcome the vision of the Bill and the commitment of the Minister. I commend the Minister for taking the Assembly’s arguments back to the Executive on the need to introduce free nursing care. Members are aware that that is a start. I appeal to the Minister to take the argument to the Executive that there is a need to look at the provision of free personal care for the elderly.
I do not want to sound negative. A start has been made, and we are on the right road. I also welcome the idea of setting up the new body for nurses and midwives. However, I, like the Committee Chairperson, look forward to the detailed scrutiny of the Bill by the Committee. I commend the Bill to the Assembly.

Mr Kieran McCarthy: I too welcome the Minister’s statement. Free nursing care for the elderly is an issue that I am familiar with, and I have wanted to see it brought to a successful conclusion. Some time ago, Mr Nigel Dodds and I brought the issue to the Floor of the House. We had the unanimous support of the Assembly at that time. This morning’s statement represents real progress. It is a positive aspect of having a local Administration and a local Minister to make decisions. No doubt the Assembly will have to study the ins and outs of the provision in detail.
I also welcome the fact that a group has been set up to examine the issue of free personal care. That issue has been another area of concern, given the division between nursing care and personal care. I am delighted to hear the Minister say that the group has been set up. She has had more success in setting up a cross-party group than I have had. I wish her good luck, and more power to her elbow. I hope that when the group reports to the Executive in June, the Executive will be receptive and see the need for free personal care along with nursing care.
This is a big subject. The Assembly must do what it can. It has the opportunity to look after Northern Ireland’s elderly people, who have been crying out for a long time. That is just one aspect of the issue. There are many others. I fully support the Bill and look forward to a successful conclusion.

Ms Bairbre de Brún: I thank Members for the interest that they have shown in the debate on the Bill. I will deal with a couple of the points that they have raised.
There is no overall increase in the number of non- departmental public bodies (NDPBs) within my Department. Although the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) is to be established as an NDPB, an existing one, the National Board for Nursing, Midwifery and Health Visiting for Northern Ireland, is to be stood down on 31March2002. Therefore, there will be no overall increase in the number of NDPBs associated with nursing and midwifery. I am sure that, as the Chairperson of the Committee for Health, Social Services and Public Safety said, they will want to pursue that point further at Committee Stage.
NIPEC’s role is to promote the development of nursing and midwifery in the areas of best practice, post- registration education and performance. With regard to best practice and practice development, NIPEC will gather information on evidence-based best practice, review how it can best be applied and disseminate details to health and social care commissioners and providers. That will help to enhance the standards of nursing and midwifery care of patients throughout the service and to develop consistently high standards of care of patients and other service users.
NIPEC will be involved in quality assuring the standard of nursing and midwifery education. It will contribute to ensuring that nurses and midwives are appropriately trained before they treat and care for patients. NIPEC will also be able to assist organisations to improve the performance of nursing and midwifery teams and the quality of nursing care of patients in general. It will be a source of advice and will be able to assist organisations in that area directly. By supporting the development of the nursing and midwifery professions, NIPEC will help to improve the care provided to service users and the wider community.
On free nursing care, I note the points raised by Mr Berry about the difficulties facing nursing homes. Indeed, as he said, that is why I put extra money in the Budget proposals to address that. However, that is a subject for another day and not specifically related to this legislation.
Ms Ramsey and Mr McCarthy mentioned free personal care. My Department has previously estimated the annual cost of providing free personal care for people in nursing and residential care homes here to be around £25 million. However, the interdepartmental group on personal care, which will advise on the costs and implications of providing free personal care, is expected to refine that estimate as part of its work. The group expects to report its findings to the Executive by the end of June this year and will seek to take full advantage of work that has already been done on free personal care in Scotland.
If I have not fully covered any area that has been raised in the debate, I will write to the Members involved. I thank Members for their interest in the debate.
Question put and agreed to.
Resolved:
That the Second Stage of the Health and Personal Social Services Bill (NIA 6/01) be agreed.

Carers and Direct Payments Bill: Further Consideration Stage

Mr Speaker: I draw the attention of the House to the fact that the short title of the Bill was the Personal Social Services (Amendment) Bill before it was amended at Consideration Stage on 4 March 2002.
Clauses 1 to 12 ordered to stand part of the Bill.
Schedule agreed to.
Long title agreed to.

Mr Speaker: That concludes the Further Consideration Stage of the Carers and Direct Payments Bill. The Bill stands referred to the Speaker.

Ambulance Service

Mr John Fee: I beg to move
That this Assembly recognises the pressures on the Ambulance Service and calls on the Minister of Health, Social Services and Public Safety to address the inability of the service to meet published response times in rural areas.
I am pleased to be able to raise what is an important issue not just for people in rural border areas, such as my constituency, but right across Northern Ireland. The motion was laid before the Business Committee in October 2001, so there is no particular significance in its timing.
I appreciate that the Minister has initiated a consultation exercise on her plans to implement a newly- revised Ambulance Service. I want to take the opportunity to impress upon her the urgency of proper resources, organisation and support for the service. People’s lives and welfare are at stake, and the service is currently in complete disarray.
I preface my next remarks with the hope that no one thinks that I am criticising in any way the personnel at the coalface who provide ambulance cover and care services for patients. It is remarkable that they manage to sustain the service given so many organisational and administrative failings across four board areas.
The context of the motion is simple. The old target for responding to emergency incidents was inside 21 minutes. I live in Crossmaglen, and it is impossible to get there from Daisy Hill Hospital in that time. I know men and women who have driven emergency vehicles and tried their damnedest to get to road traffic accidents or cardiac and other emergencies in the required time, but it is physically impossible. That goes for a large part of my Newry and Armagh constituency, from the Ballsmill area through Glasdrummond to Creggan, Crossmaglen, round to Cullyhanna and on bad days even to Newtownhamilton. There are between 10,000 and 15,000 people who are permanently outside the safe response time for accident and emergency vehicles. I am sure that the situation is the same in the Augher/Clogher valley and in parts of Fermanagh and the Glens of Antrim. Until recently, it applied to substantial parts of the Mournes area. Many people are, therefore, without the basic emergency medical cover recommended by the old Operational Research Consultants standards, and those people will be even further disadvantaged by the strategic review of the Ambulance Service and the new implementation strategy.
Resources will be discussed later in the debate. However, although they are important, resources are not the key issue. The strategic review of the Ambulance Service published in 2000 recommended that 50% of all 999 calls could be reached in under eight minutes. That could be achieved by improving the availability of accident and emergency ambulances, and no additional resources were required.
That is what this is all about. Currently the service is so poorly organised and strapped by bureaucracy that even with existing resources the necessary service and response times are not achieved. The general public is probably not aware that the Ambulance Service in Northern Ireland is not classified as an emergency service, and neither is it treated or funded as such. Were the Fire Authority to ask for money to provide a service or the police to ask for money for training or new personnel or whatever, it would come from central funding, and there would be no quibbling. That funding is ring-fenced.
The Ambulance Service does not work that way. It has no single budget or single source of finance. It must sell the boards the number of miles travelled, the numbers of incidents dealt with and journeys made. It is impossible to manage a service in that way. If a core budget is not guaranteed year-on-year, and administered by a central authority, staff cannot be properly trained, the estate cannot be properly managed, and the fleet cannot be properly developed. If I ask the Minister to take any action as a result of this debate, it will be to look at the funding arrangements for the Ambulance Service and to put it on a par with the other emergency services, so that it can prepare, plan and manage the service.
I now make a plea for my own area. The original strategy published in 2000 recommended that an additional 20 ambulance centres be established. In the Minister’s revised implementation programme, that figure was reduced to nine, in addition to the two that have already been developed. That will leave a substantial part of the North of Ireland without the necessary cover, and it will continue to leave substantial parts of areas such as south Armagh beyond the eight-minute response times. Sections of the community in Fermanagh, Armagh, Antrim and Down will be left outside safe response times for the foreseeable future. Surely that is not what the Minister or the Department intends. It is certainly not what communities need or want.
Why was no meeting held anywhere in Newry, Armagh or south Armagh as part of the consultation exercise? Why, at the meeting held in Banbridge, was there no mention of any additional ambulance centres for the broad swathe of land around the border?
This process has been ongoing since the review of ambulance services was commissioned by John McFall in October 1998. The review was published in 2000, and the implementation document was then produced. That document is out for consultation at the moment. Ambulance services exist to respond to immediate life-threatening situations. If parts of the problem can be clearly identified and solved before the review is finished, I ask the Minister to do that.
There are problems with the fleet, and I ask the Minister to renew her bids for money to upgrade it. There are also problems with the dispatch and communication systems. Until the review is complete, will the Minister ensure that all software, hardware and technology is properly tested in a Northern Ireland context? England had months of poorly recorded or missed 999-calls. I hope that the preparatory work has begun, but I do not see many signs of that.
Ambulance staff and paramedics are misused. We must address a system that allows highly trained people with well-equipped ambulances to provide, for want of a better term, a taxi service. People must be brought to day-care and outpatient services, but the resources of the ambulance and accident and emergency services should not be drained by a job that others could do.
In going through some papers for today’s debate, I was shocked to realise that there is no guarantee of a trained paramedic in any ambulance dispatched. It is shocking that our accident and emergency services might dispatch an ambulance without a paramedic to a road traffic accident or to someone with an ectopic pregnancy or someone having a heart attack. We must address that urgently before we deal with anything else.

Mr Barry McElduff: I beg to move the following amendment: Insert after "rural areas":
"and further calls on the Executive to provide sufficient funding to allow for the early implementation of the Strategic Review of Ambulance Services."
Go raibh maith agat, a Cheann Comhairle. Ba mhaith liom tacaíocht a thabhairt do rún John Fee agus cúpla pointe eile a chur san áireamh fosta.
I commend John Fee on tabling the motion, and I would like to add to it. I attest to the experiences of people living in rural areas, such as County Armagh, which Mr Fee also outlined. I am aware of the particular difficulties experienced by people living in areas of pronounced rurality such as County Tyrone, south Derry and County Fermanagh with regard to ambulance provision. They often have to make their way to hospital in private vehicles or neighbours’ vehicles. People living in rural areas such as Cranagh on the Tyrone/Derry border also share that fear and anxiety when trying to access essential health services, and, unfortunately, the response times are not being met.
I share concerns about the downward revision of the targets set by the Department and the Minister. Everyone would like to see improved response times and improvements in survival rates, and that is at the heart of the overall ambulance review.
In tabling the amendment, my Colleague, Ms Ramsey, and I wish to draw attention to the most fundamental issue of all — resources. We are highlighting the link between Ambulance Service improvement and the adequate provision of resources. The Minister has often stated publicly that it will be a long haul to remedy past funding failures. There is a recognised lack of capacity in the Health Service. We must put that capacity back into the service and, specifically, into the Ambulance Service.
We need a commitment to long-term planning arrangements. Last night, the key message from the chief executive, Mr Lindsey, and the chairman, Mr Bradley, of the Western Health and Social Services Board was that there is a need for certainty about future funding levels.
While I welcome the Minister of Health, Social Services and Public Safety’s presence today, I would also like to have seen Mr P Robinson attend. In order to have joined- up government, the Department of Health, Social Services and Public Safety, the Department for Regional Development and other Departments must work closely together. Rurality and poor roads infrastructure go hand in hand — they are virtually synonymous. The combined efforts of Executive Ministers are required to address that problem, and I hope that Mr Robinson will join those Ministers in making the case for greater funding and for greater emphasis to be placed on improving rural roads infrastructure. Those issues are central to the overall problem that has been highlighted in the motion.
To achieve more effective and efficient ambulance provision, cross-border co-operation must be strengthened — in fact, the border must simply disappear. People living in parts of the North can access hospitals in Sligo and Cavan more easily than they can access hospitals in a more northerly location. Therefore, while I agree with virtually all of Mr Fee’s sentiments, I would like the Executive to match that vision with resources.

Dr Joe Hendron: I welcome the opportunity to participate in this debate. The pressures faced by the Ambulance Service in meeting its responses times are of vital importance to all Members, their families and their constituents.
Every person in need of an emergency ambulance should expect equity of access to ambulance services. That means a speedy response time and proper equipment.
The improvement of service provision is of fundamental importance to my Committee. The Committee will have failed to do its job if it does not seek answers when a public body such as the Ambulance Service falls short of its key targets. I stress the admiration that my Committee and I have for the staff of the Ambulance Service, who do an incredibly difficult job extremely well with limited resources.
The Health Committee has considered the pressures faced by the Ambulance Service on many occasions. Most recently, Members examined the implementation plans of the Department of Health, Social Services and Public Safety for its strategic review of the Ambulance Service, ‘Mapping the Road to Change: A Strategic Review of the Northern Ireland Ambulance Service’, which sets out a phased programme of improvements to ensure that response time targets can be met in the future.
Committee Members also met recently with the chairperson and chief executive of the Northern Ireland Ambulance Service to discuss concerns about the ability of the Ambulance Service to meet, at the very least, the standards set for England, Scotland, and Wales. We should strive to meet not only the standards set in these islands but the best international standards. The public deserves no less.
We have heard that the Ambulance Service is not meeting its response time targets. Only 50% of calls are responded to within the eight-minute target time in the Eastern Board and Western Board areas, and the performance rate for the Northern Board and Southern Board areas is that only 46% of all calls are met within eight minutes.
Within those figures, there is considerable variability of performance across local government district areas. The problem affects rural areas hardest, especially remote areas. This problem was recognised by the Minister and her Department when she undertook the strategic review of ambulance services. The Committee welcomes the Minister’s proposals to improve response times, and it will monitor their implementation to ensure that the Department acts without delay to improve services.
Fundamental to the problems facing the Ambulance Service are the resources needed to do the job. The lack of adequate resources affects the number of ambulances and crews available and their ability to meet the response targets. Only two thirds of the emergency ambulance fleet have paramedics on board. The public should expect a paramedic on every emergency ambulance. Funding also affects areas such as training, communications and morale.
However, it is not only about extra resources; it is also about the efficient use of existing resources. One example is the need for improved co-ordination of emergency ambulance services across the four health boards. The emergency co-ordination centre at Knockbracken Healthcare Park in Belfast handles work for the Eastern Board and the Northern Board. The centre should be used as a template for a regional emergency co- ordination centre, which would help the service to use its resources more effectively to meet targets.
Funding comparisons have pointed to a significant difference in the money available per head of population. Northern Ireland receives £14·50 per head, Scotland, £20 per head, and Wales, £22 per head. That difference must be redressed. The Minister’s most recent bid, for £6·2 million to resource the implementation of the strategic review of the Ambulance Service in 2002-03, failed.
The emergency Ambulance Service is a cornerstone of the Health Service, and the public needs to be reassured that lives are not being put at risk due to the inadequate funding of this service. The service needs an adequate level of resources if it is to meet the performance standards, and the Health Committee will give its full support to the Minister in her efforts to obtain a fair proportion of funding for the Health Service and for ambulance services.
UNISON has sent a paper to all Members, and I want to highlight one point that is made in it:
"There remains no awareness in the implementation document of an understanding of how poverty-related health and TSN issues need to be incorporated in targeting resources towards individual districts or groups of districts. This is particularly relevant when local government boundaries are under review in the review of public administration."
I have made my final point on several occasions. Having been involved in primary care as a GP for many years, during all sorts of troubles, I have never known any ambulance driver to hold back in an emergency situation, no matter how much violence there was on the streets. I have great admiration for them.

Rev Robert Coulter: I support the motion and commend Mr Fee for moving it at this time. For far too long the Ambulance Service has been regarded merely as patient transport and not as an emergency service, but the time has come when we must look on the Ambulance Service as a pre-hospital healthcare service. It will be an essential part of the review of acute hospitals. It is a healthcare provider that makes life better for patients in many different ways.
Emergency care can be influenced heavily in the pre-hospital phase. There is great talk about the "golden hour", but it is coming down to the "golden half-hour". In England and Wales it has been recommended that the time from when a call is received until the patient is at the door of an accident and emergency department should not exceed 30 minutes. According to the equality impact assessment of the Department of Health, Social Services and Public Safety, published in November 2001, the performance figures from some local government districts are: Carrickfergus 14%; Banbridge 18%; Limavady 30%; Moyle 33%; North Down 30%. And so it goes on. Is 14% an acceptable figure? I do not think so.
Standardisation of performance is necessary, taking rural and urban areas into account. It is easy to set times and to accept that the Ambulance Service is clinically meaningful. However, we must ask ourselves whether those times are operationally achievable. If they are not, we must ask ourselves how we can make them operationally achievable.
Modern technology is available. Have our ambulances been fitted with automatic vehicle location? It is easy to send ambulances to different locations, but if an ambulance is answering a call that is not an emergency and then has to be diverted to an emergency call, surely it makes sense that it should be fitted with an automatic vehicle location system. Satellite direction to homes is another absolute must for the future. How much time is lost because ambulances cannot find the exact location of an accident or a home where there has been a cardiac arrest?
I am glad that digital radio will be installed in ambulances. As Mr Fee said, there are many radio black spots in our country, but in order to have an ambulance service that can achieve the set times, there must be total coverage. That point is important. However, any equipment for ambulances should be properly tested in a Northern Ireland context before it is purchased.
I thank the Minister for her response, which I received this morning, to my question on stretcher beds. Many of the stretchers in ambulances are unacceptable, and it will cost a tremendous amount of money to replace them. Therefore, it is imperative that all equipment in ambulances should be properly tested before it is installed.
I also ask the Minister to take on board the difference between the retirement age of Fire Service personnel and ambulance personnel. The work of an ambulance crew can be heavy and stressful. Many ambulance personnel, when they reach the age of 63 or 64, find the work extremely heavy. They are unable to carry out the work as they should because their backs are being strained and so forth. In the Fire Service, one can retire at an earlier age.
I do not want to repeat many of the points that have already been made. Suffice it to say that the annual report of the Ambulance Service is correct when it states that this is a matter of life and death. Therefore, priority must be given to ensuring that the Ambulance Service is the best in the United Kingdom.

Mr Paul Berry: I support the motion in the name of Mr John Fee and welcome the fact that the motion has been tabled. It is an important matter that must be debated.
Health Committee members met the chief executive of the Northern Ireland Ambulance Service several weeks ago. Indeed, the Committee meets regularly with Ambulance Service staff, who highlight the problems that they face. The motion outlines not only the pressures that they are under but also the response times in rural areas. The Ambulance Service is under immense pressure at times.
Within the Health Service as a whole, we are back once again to the issue of resources. Much of the document ‘Mapping the Road to Change: A Strategic Review of the Northern Ireland Ambulance Service’ outlines the need for more funding and more resources. We must zoom in closely on those issues. The Chairperson of the Committee for Health, Social Services and Public Safety referred to the funding comparison per capita, where Northern Ireland is the lowest, followed by Scotland and Wales. I trust that the Department will take that issue on board, because it must be addressed.
Rev Robert Coulter raised the issue of the impact of acute hospital reorganisation. All those aspects and issues are most important, so that we get the Ambulance Service right not only for the needs of the people who will use the service but for the needs of the staff who are currently under immense pressure.
Delegations from the Ambulance Service have repeatedly made it clear to us that the funding allocation was totally inadequate to meet the needs of staff training, fleet replacement and prioritising investment within the service. Another major issue that was brought before us was the communications system, which also needs investment. When Committee members met departmental officials, we were glad to learn that, under the Executive programme funds, allocations have been provided for two key Ambulance Service developments in 2002-03. One of those relates to the introduction of digital trunk radio to improve communications between the Ambulance Service control, ambulances and hospitals.
(Mr Deputy Speaker [Mr J Wilson] in the Chair)
An important issue for the Department to take on board is the possibility of examining the amalgamation of the Fire Service and the Ambulance Service. When the Committee met the chief executive of the Ambulance Service and his colleagues, it was stated that there was a need for a joint approach in relation to the communications of those two important emergency services. One needs to work with the other. The Department must examine the possible amalgamation of those services, in addition to the amalgamation of the communication services. That would help both organisations, and it would also help to address the emergency needs in our community. That would also help with the implementation of a rapid response scheme that would provide for faster responses to emergencies, particularly in rural areas.
In introducing this motion, Mr Fee outlined the needs of rural communities and the concerns and problems associated with response times. The amalgamation of communication services could be addressed to deal with that problem. Staffing and staff training were also outlined.
Violent attacks on Ambulance Service staff is one of the biggest issues that the service has had to face recently. Rev Robert Coulter referred to the retirement age of 65. Many staff have to work 12-hour shifts, coping with manual handling and stressful situations. The retirement age in the Fire Service is 55. Eight per cent of sickness absence in the Ambulance Service relates to exhaustion, back trouble, stress, violence and age-related problems. The Committee has been told by departmental officials that those issues will be taken on board. Those important staffing issues must be addressed immediately. A person of 65 years of age who has to deal with equipment in an ambulance can be under severe pressure, and the sickness rate proves that.
The level and extent of training must be improved. There is a shortage of paramedics, and an ongoing training programme for new staff and a refresher course for existing staff must be addressed.
Members will be strongly opposed to attacks on Ambulance Service staff, and all staff who work in the Health Service and the public sector. It is sickening to think that the people who need the service are at risk because of those attacks on staff that make the response times impossible to meet. Like other Members, I condemn the attacks on Ambulance Service staff.
When the Committee met the Department it learnt that money was being provided to deal with the raising of awareness in schools. The Committee was glad to learn that a pilot community education programme has been funded through the Department to raise awareness. Education programmes in schools will address the importance of the Ambulance Service and its work.
The Fire Service has an education programme in schools to highlight the importance and the need for that emergency service. About a month ago, concern was expressed to the Committee that there was no such programme available in the Ambulance Service. Members were glad to learn from the Department that that issue is being addressed, and we trust that it will have a positive outcome for the betterment not only of the Ambulance Service but also the whole community.
Fortunately, those attacks have stopped, and we trust that we will not hear of any more attacks on the Ambulance Service, the police, the Fire Service or any other people in the community.
Response times in rural areas are another major problem, and other Members have highlighted the issue well. Unfortunately, Northern Ireland is falling behind Great Britain in basic standards of service provision, fleet maintenance and training. That is due to a lack of funding, and it will affect our ability to meet the standards for response times to emergency calls. Our constituents deserve better, and the Ambulance Service deserves better. The service is working under extreme pressure due to a lack of funding, and the Department must address that issue not only for the sake of our constituents but also for Ambulance Service staff. We commend the staff of the Ambulance Service for working under such extreme pressures. We must represent them to the best of our ability. I trust that all the issues mentioned will be taken on board and that action will be taken on many of the concerns that have been raised. I support the motion.

Mr Kieran McCarthy: On behalf of the Alliance Party, I want to put on record our thanks and appreciation to all members of the Ambulance Service who have served the entire community through years of murder and mayhem and who have been in the forefront of picking up the pieces, whether as a result of bombing, shooting, car accidents or other incidents. They have done, and continue to do, a superb job. As Mr Berry said, we hope that the recent and ongoing assaults on the Ambulance Service will cease immediately so that staff can get on with what they have been trained to do.
I hope that by having a debate on the Ambulance Service we will contribute to the overall well-being of everyone in the community and see co-operation between all those involved in the Ambulance Service. We are grateful for Mr Fee’s motion.
The emphasis is on rural areas such as the Strangford constituency, which I represent. As I understand it, the eastern division is classified as rural and, therefore, must meet the performance standards for a rural area. The acute hospital services review recommends that there should be a significant increase in investment in the Ambulance Service. The Minister has endorsed detailed plans to secure improvements to the availability and quality of the Ambulance Service throughout Northern Ireland. We wish her every success in her endeavours.
I shall highlight some figures that emphasise the need to introduce a medical priority despatch system. Presently, calls to the Ambulance Service are not prioritised. Prioritisation has been introduced in all ambulance services in England, but not in Northern Ireland. The Alliance Party endorses its implementation here, starting with a pilot in the Eastern Health and Social Services Board area.
The targets in England for non-prioritised calls are the same as for Northern Ireland. Within each board area, 50% of all emergency calls must be answered within eight minutes. In the Eastern Health and Social Services Board area, 95% of all emergency calls must be answered within 18 minutes, and within 21 minutes in the other three board areas. The two regions compare similarly. Our four health and social services boards are not the best, but they are not the worst. In handling over 35,000 emergency calls, the Eastern Health and Social Services Board responded to 62·7% of those within eight minutes and 96·9% within the 18 minutes to 21 minutes target.
In order that the implementation proposals can improve response time, the new medical priority despatch system must be introduced. I appeal to the Minister and her Department to launch a public awareness campaign to emphasise the equality implications for patients in the new patient care services.
The strategic review implementation proposals go further than the exercise in England by establishing targets for local government districts. That decision is to be welcomed, and it will provide more detailed and honest figures and evaluations of performances. The Alliance Party supports any proposals that can get an ambulance to where it is needed in as short a time as possible and hopes that additional accident and emergency vehicles and crews will operate in outlying rural areas such as Saintfield, Killyleagh and Portaferry. Portaferry is at the tip of the Ards Peninsula, and anything that will reduce precious time in an emergency must be provided. I appeal to the Minister to ensure that those proposals are implemented as soon as possible.
I was pleased to hear the Minister say this morning that progress is being made on the all-Ireland air ambulance service.
I support the motion.

Mr Norman Boyd: I wish to place on record my personal appreciation, and that of my party Colleagues, to the Northern Ireland Ambulance Service for its dedication and professionalism in serving the entire community with impartiality and displaying great courage over many years.
It is appalling that there are those in society who are prepared to attack ambulance staff and other members of the emergency services as they carry out their duties. The attacks must stop, and the courts must deal adequately with those who are guilty of such disgraceful attacks. There are an alarming number of attacks on ambulance staff and other staff inside and outside hospitals. This escalating problem must be effectively addressed. In 2000-01 reported incidents of violence against ambulance staff totalled 71, in comparison with 43 in the previous year. It is vital that the general public supports the Ambulance Service and helps to eradicate the attacks.
The speed of response of ambulances to accident and emergency situations is critical at the time of a call and at attendance at the scene. There is concern, however, that some response targets are not being achieved. In the financial year 2000-01 two of the four health board areas — the Northern Board with 47% and the Southern Board with 42% — did not achieve the 50% target for accident and emergency ambulances to arrive at the scene in eight minutes. It is vital that, in emergencies, intervention and treatment for life-threatening conditions such as cardiac arrest begin as quickly as possible after the onset of the arrest. The targets of 95% of accident and emergency ambulances reaching the scene in 18 minutes for urban areas and 21 minutes for rural areas were not achieved in three of the four health board areas in 2000-01: the Northern Board with 94%, the Southern Board with 92% and the Western Board with 94%.
There were over 71,000 emergency calls in 2000-01, and the responses that were not achieved within the performance standard amount to several hundred in some areas. The times for each ambulance station over the quarter ending 31 December 2001 for response at the scene in eight minutes have a wide variance. In the Eastern Board area, the highest response rate is Ardoyne station at 71%, and the lowest is Downpatrick at 35%. In the Western Board, the highest response rate is Altnagelvin station at 59%, and the lowest is Castlederg at 37%. The Northern Board also has a large variance. The highest response rate is Antrim at 58%, and the lowest is Ballymoney at 32%. In the Southern Board, the highest response rate is Newry station at 53%, and the lowest is Craigavon at 30%.
It is clear that some response times must be improved and greater consistency achieved, particularly in rural areas. The necessary resources must be made available, and measures must be put in place to achieve the required improvements in response times as a priority.

Mr Jim Shannon: I support the motion. It is important to examine what the Ambulance Service offers.
A wid be for pitten forrit ma consarn that, for aw the unanimous council uphauld for upsettin an ambulance ootstation on the Airds Peninsula, the Halth Meinister haesna setten oot onie plans for sicna ploy.
The Norlin Airland Ambulance Service haed an apen forgaitherin in the Strangford Airms Hotel in the Newtoun no lang syne for ti gae ower its propones for the haill Province an for the airt o Airds Burgh Council in parteiclar. It is clair that the Ambulance Service haes been in sairious want o siller in bygaen yeirs, gettin nae mair nor aboot £14 for ilk indwaller, an makkin compare wi Scotland an Wales the differ’s neir £10 a heid. Deed, thir feigurs is e’en mair flegsum whan we tak the Fire Service. The Govrenment maun gie the dounhauden Ambulance Service the siller it’s wantin that sair.
Airds Burgh Council haes been threipin for an ootstation on the Airds Peninsula thir 12 yeir, an that needcessitie haes cum til the fore as the population haes growne. The loanins o the Airds Peninsula is jaggit an nairrie, an the maist fek o fowk’s bydin in the kintra an spreid oot. In the simmer the nummer indwallers fair gaes up, bi sae mukkil as 20,000. The tyme taen winnin til the steid o an accident in the laicher Airds Peninsula is up a lang wey, an the nummer lyfes tint haes growne flegsum.
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I am concerned that, despite unanimous support from the district council — and I wear two hats for this — for the provision of an ambulance outstation on the Ards Peninsula, there have not been any plans for one under the current Health Minister or in the current Ambulance Service proposals.
We are here today to discuss rural needs in relation to ambulance provision. The Northern Ireland Ambulance Service recently held a public meeting in the Strangford Arms Hotel in Newtownards to outline its proposals for the Province as a whole and for the Ards Borough Council area in particular. The Ambulance Service has been seriously underfunded over the years, and we were given dramatic figures at that meeting. We spend only £14 per person, as much as £10 less than Scotland and Wales. When compared with the Northern Ireland Fire Authority, the figures were even more dramatic.
The Government, and the Department, must take steps to provide the funding that the hard-pressed Ambulance Service is desperate for. For 12 years Ards Borough Council has pressed hard for an outstation on the Ards Peninsula. It knows the needs and tries to reflect them. That commitment, and the need itself, has grown as the population has increased. The roads of the Ards Peninsula are, by nature, twisty and narrow, and the population is predominantly rural and widely spread. In the summer, the population grows by as many as 20,000 people, so it takes even longer to get to an accident on the lower Ards Peninsula, and that could result in a dramatic increase in the number of deaths.
It seems that the major reasons for the inability of the Ambulance Service to upgrade and provide better and more efficient services are money and manpower. As the problem continues and the Ambulance Service in the Province falls further behind, it could well be time to consider some short-term assistance. There is an organisation called ProParamedics, which is a professional, experienced group that is willing and able to assist. It has trained and expert staff, who already assist at a number of venues in the Province. It has come into being because the Ambulance Service and St John Ambulance — a voluntary group — have not been able to assist due to financial and manpower restrictions. Staff resources are already being squeezed.
I request that ProParamedics be fully considered if substantial manpower and funding are not made available immediately. It says that it can offer a service at a much better and competitive rate and be there within the prescribed time to meet all emergencies. It is available. Even if full training took place today for Ambulance Service personnel, they might not be ready to take up their posts right away.
Problems are further exacerbated because ambulances are able to take only one injured person to hospital at a time; in serious accidents the numbers of ambulances needed increase greatly. The pressure is on the Ambulance Service, and a fair and positive response for outstations or rapid-response units must take place — not, as we have been told, at a predetermined location; there has to be a full and fair look at the entire Province.
I call on the Minister and the Ambulance Service to create a rapid-response centre and outstation on the Ards Peninsula, which has already been justified by its needs. The outstation or rapid-response method could work effectively for the peninsula, perhaps working out of the health centre in Kircubbin. Again, I put that forward as a suggestion. It would be a clear and direct way of trying to help. There is a centre there that could be made available, and it could well be the outstation or rapid-response centre for the peninsula.
It is, therefore, disappointing that the commitment we sought from the Ambulance Service for the outstation has not been forthcoming. Perhaps the Minister can confirm that no decisions have been made, that nothing is predetermined, and that the outstation for the Ards Peninsula is still in the running. The Department said that there would be three pilot schemes for the Province but suggested that other places would probably be chosen. On three occasions it mentioned three places: the Sperrins, the Glens of Antrim and Fermanagh. I am not saying that any of those locations should not get the outstations, but the Ards Peninsula needs one more than most.
The outstation is crucial for people there. It is imperative to ensure a shorter response time for accidents and injuries, and I implore the Ambulance Service and the Department to review the situation and ensure that there is a pilot scheme for the Ards Peninsula. So far they have failed to deliver any sort of assurance to elected representatives. There is still time, and opportunity, to ensure that the Ards Peninsula gets its much needed and long overdue ambulance provision. Time, effort and need demand it.

Ms Bairbre de Brún: Go raibh maith agat, a LeasCheann Comhairle. Gabhaim buíochas leis an Uasal Ó Fiach as an ábhar seo a thabhairt os comhair an Tí. D’éist mé go cúramach leis na tuairimí a léirigh Comhaltaí agus tá áthas orm deis a bheith agam sa díospóireacht seo na fadhbanna atá ag an tSeirbhís Otharcharr a mheas. Is cuid dhílis na seirbhísí sláinte agus pearsanta sóisialta í an tSeirbhís seo, agus tá gá le soláthar éifeachtach éifeachtúil otharcharr má tá beo go leor daoine gortaithe agus breoite le sábháil gach bliain.
I thank Mr Fee for bringing this matter to the House. I have listened with interest to the views expressed and welcome the opportunity that the debate has provided to consider the problems facing the Ambulance Service, which is an integral and important part of health and personal social services, as has been stated in the debate. Efficient and effective ambulance provision is essential if the lives of many injured and sick people are to be saved each year.
The key performance measure for the Ambulance Service is its ability to meet clearly defined response standards. The current targets for the service are to respond within eight minutes to 50% of all emergency calls, to respond to 95% of all emergency calls within 18 minutes in the Eastern Board area and within 21 minutes in all other board areas. As has been made clear these standards are met only in the Eastern and Western Board areas, and within them there is considerable variation in performance. It is no coincidence that the areas in which the Ambulance Service fails to meet current response targets are mainly, though not exclusively, rural areas.
The implementation plan and the strategic review of the Ambulance Service contain a series of measures to reduce the differentials between urban and rural areas, to improve overall response times and to improve the quality of responses by the provision of enhanced staff training. The plan sets out clearly the need for fundamental investment in the service if it is to make these improvements, and it is specific on what is required and the likely costs. Several Members took up that point.
However, there has been, and continues to be, significant investment in the Ambulance Service — over the last three years, over 100 new vehicles have been put on the road. Significant investment has been made in new equipment and in the training and development of staff.
One of the recommendations of the implementation plan is that there should be additional response points for accident and emergency ambulances to enable the travelling time to incidents to be reduced. Four additional response points are on stream, and more are planned.
The recommendation of the strategic review for 20 more locations was not supported by any statistical information. The issue is revised and revisited in the proposed implementation plan, based on computer-modelling of locations and response times. I can confirm that 11 additional locations are proposed and that consultation meetings have already identified alternative locations based on local knowledge.
I am also pleased to confirm that, as well as additional resources for the coming year, an additional £300,000 will be made available next year to begin the medical priority despatch system — a protocol which will help ambulance control staff to determine whether an incident is life-threatening and thus use existing resources more effectively; to improve the 24-hour on-call arrangements for responses to major incidents; to put in place measures to address problems with attacks on ambulance staff, including a trial programme to help prepare crews to deal with potentially violent situations; and a pilot community education programme for children and young people. That is on top of the additional £1 million already available to the Ambulance Service for 2002-03 for training and developing paramedics and other staff.
I have also secured a total of £3·2 million for digital trunk radio systems and rapid responder schemes, £1·1 million of which will be available to the Ambulance Service in 2002-03. The introduction of digital trunk radio provides for clearer and more secure communications between ambulance control staff and the other emergency services and will have many benefits in relation to the quality and timing of responses to emergency calls.
In that respect, I noted the points that Mr Berry made about closer communication systems and working together. Recent discussions and work have focused on closer co-operation between the Fire Service and the Ambulance Service. That is one of the reasons why the two services were put into the same Department — the Department of Health, Social Services and Public Safety — when the new arrangements were made.
I note with some regret that Mr Berry kept talking about what he had heard from departmental officials when he was quoting the responses that I had given to him face to face, when I met with him and his Committee colleagues in order to discuss budget proposals. Given that I had the professionalism to provide those responses, I hope that after this morning he will remember that they came from me.
The rapid responder schemes will have a particularly important role in improving the response in rural areas. There will be four rapid responder four-wheel drive vehicles — one in each of the board areas — each driven by a paramedic. Those vehicles will be situated in areas where the response times are particularly poor because of rural isolation or poor road networks. In addition, plans have been developed for pilot first responder schemes in rural areas, under the remit of the North/South Ministerial Council (NSMC). Those schemes will train people from the community in basic life-saving skills, so that they can provide support in the vital minutes that it takes for an ambulance to arrive on the scene.
Although I have concentrated on speed of response, which is of obvious significance, simply improving response times will not improve clinical outcomes for patients. Increasingly, the focus has been turning towards the quality of care that Ambulance Service personnel provide before a patient arrives at hospital. Recommendations in that area include improvements in training and development and the introduction of clinical audit procedures and systems. Ambulance Service is continually examining ways to improve the quality of service that it delivers. Over the past three years I have been able to make over £3 million available for Ambulance Service modernisation. I have also secured over £3 million with which to improve Ambulance Service communications and to pilot rapid-responder schemes.
The provision of those measures — the additional ambulance locations, the rapid-responder schemes, the introduction of first-responder schemes and the strategic deployment of ambulances — as identified in the implementation plan, are measures specifically designed to improve response times in rural areas. However, the extent to which various measures can be initiated — including the provision of paramedics — depends largely on the availability of the additional resources. The Chairperson of the Committee for Health, Social Services and Public Safety has already mentioned that my most recent bid was not met. However, I assure Members that, as they requested this morning, I will continue to bid for resources for that important aspect of my Department’s services. The issue of roads was raised this morning. However, it is not within my remit and is a matter for the Minister for Regional Development.
Public consultation meetings took place in locations with the poorest response times in each board area. As part of the consultation process departmental officials offered to meet with any group wishing to air their views in that way. Several meetings have taken place in response to such requests. Those are continuing, even though the formal end of the consultation period was 15 February 2002. A request from Newry and Mourne Health and Social Services Trust was made at the end of last week. Arrangements are currently being made for that meeting.
In relation to the question about ambulances being used as a taxi service, the strategic review report highlighted the inappropriate use of accident and emergency (A&E) vehicles in the transport of patients to and from hospital appointments. The proposed separation of the management of A&E and patient care services (PCS) and further investment in the A&E and PCS fleets will ensure that A&E vehicles will not be diverted away from emergency calls.
The Ambulance Service is also aware of the need to make the public aware of what the medical priority despatch system will be, and it will introduce a public awareness programme. The Department will provide appropriate support to ensure that public concerns about the medical priority despatch system are addressed effectively.
Bob Coulter mentioned the retirement age for Ambulance Service personnel. That is not locally negotiated but is carried out in England as part of the normal negotiations on pay and conditions of service.
Violence against ambulance staff is of great concern to us all. The Ambulance Service has been in discussions with staff-side representatives about the measures it could take to minimise the risk to ambulance crews. I will meet representatives from UNISON to discuss that issue in the near future. In the meantime, my officials and Ambulance Service management are looking at initiatives to better protect staff and preclude further attacks, such as more robust windscreens in vehicles and community education projects, which I mentioned earlier.
Direct comparisons with response times of other ambulance services are not possible. The performance of GB services is measured on the basis of emergency calls categorised by level of urgency, and GB ambulance services are required to respond to 75% of life-threatening — or category A — calls within eight minutes.
The recognition of the Ambulance Service as an emergency service was mentioned. Ambulance services are provided to ensure that people who are ill can access health services under the provision of the Health and Personal Social Services (Northern Ireland) Order 1972. The accident and emergency ambulance service is generally perceived as an emergency service, but my officials are investigating what benefits, if any, would result from formally recognising it as such.
As regards regional funding, the proposed new commissioning arrangements are intended to result in a co-ordinated, corporate approach to the development of the Ambulance Service. Health and social services boards currently negotiate with the ambulance trust individually. The new model is based on a single commissioning group, including representatives from the four health and social services boards. Through that group, new service developments will be agreed on a regional basis.
Important though the recent and planned investments are, as is the work that we have taken forward to date, they fall short of the full implementation plan. There is a significant additional cost to implementing all measures proposed in the plan. For example, to achieve a 50% response rate to all emergency calls in all board areas within eight minutes will require a recurrent minimum allocation for ambulance services of £3 million a year.
To meet other more ambitious response time targets, additional funding of £8 million a year would be required for the first two years, with a minimum of £5 million a year thereafter. That is against a background of a limited departmental budget and the continuing pressures across the whole spectrum of health and personal social services. Therefore the speed at which improvements can be achieved will depend on the level of additional funding available. The Chairperson of the Committee for Health, Social Services and Public Safety referred to the fate of bids that I made this year.
Responses to the consultation on the implementation of the strategic review are being collated and evaluated. I will, in due course, feed the key messages from that back to Members. However, on the basis of the consultation so far, people clearly have genuine concerns about the need to improve the Ambulance Service, and response times in particular. In that respect, I welcome today’s debate on those issues.
Significant investment in additional ambulances and crews is required to improve response times. I have sought every opportunity to provide additional funds for the Ambulance Service and will continue to do so. Indeed, I will continue to press and to take every opportunity to try to secure and provide additional funds for this vital service. I recognise that, even in these times of pressure on services overall, the Ambulance Service must be seen as a key element in providing effective and equitable healthcare for everyone.

Ms Sue Ramsey: Go raibh maith agat, a LeasCheann Comhairle. I too commend Mr John Fee for moving this motion, and I will add to the reasons outlined by my Colleague, Barry McElduff, for moving an amendment to it. I also take the opportunity to commend and thank the Ambulance Service staff for their years of hard work and dedication and to point out that the level of attacks on staff has increased and must stop. The Committee for Health, Social Services and Public Safety discussed the matter last week.
The debate was mature and informed and covered the issues faced by the Ambulance Service. I agree with John Fee that the ring-fencing of money must be examined and that the Ambulance Service cannot develop without a proper budget and funding, and I will come back to that later. The basis of the amendment is that many of the services in the Department of Health, Social Services and Public Safety cannot operate without long-term strategic funding.
I agree with the many Members who referred to the poor response time in rural areas. We must compare that with the time taken to respond in urban areas. With regard to a joined-up, collective approach, I commend the Minister for Regional Development for his presence throughout most of the debate. I hope that he and his officials will read Hansard closely and take note of what has been said about the roads infrastructure.
The Health Service has been underfunded for years. Sadly, it has reached a stage where money is scarce and different parts of the sector are fighting each other for it. That must be examined. The need for £57 million to build a new cancer centre was discussed as recently as 5 March. Earlier today we spoke of additional money for free care of the elderly. We have talked recently about money needed for children’s services, community care, the acute sector, the Fire Service and the Ambulance Service. One is no more important than the other, but the list is endless, and I apologise if anything has been missed.
Health was made a priority in the Programme for Government, and that fact must be addressed. The Executive have said that they will deal with health as a priority, and it must be impressed upon them that proper long-term funding is necessary. It is sad that lives are at risk if the Executive do not commit resources to resolving the matter.
I thank the Minister for her attendance at the debate and for the statement she made earlier regarding North/ South co-operation. The all-island accident and emergency service mentioned earlier today is an example of that. That service would improve the situation in the border counties.
With regard to the point about the infrastructure, the Department for Regional Development appealed to the goodwill of farmers concerning the gritting of roads. That collective approach and response solved some of the problems.
I agree with the Chairperson of the Committee for Health, Social Services and Public Safety that it is important for the Ambulance Service to meet response times. It is pointless to specify such times if the will to meet them is not there, but its absence is again linked to underfunding.
I agree with Joe Hendron that the Committee welcomes the Minister’s proposals to improve response times. As he says, health boards must co-operate to improve the response times of ambulances. He also pointed out that the Minister had made a bid for £6·2 million for the Ambulance Service. That bid was not approved by the Executive. Again, I must ask whether that demonstrates that health is a priority for the Executive, because it does not seem so to me.
I agree with Bob Coulter that the Ambulance Service is sometimes seen as a personal bus service or patient transport service. I also agree that we must consider the retirement age for ambulance personnel and take on board the Minister’s comments. The Committee must look at that closely, because it is decided and negotiated in England.
Paul Berry mentioned the need for more funding and resources. As a fellow member of the Committee for Health, Social Services and Public Safety, I support him. We are all aware of the lack of funding for the service, and we should not have to decide to fund certain provisions to the exclusion of others. Like Paul Berry, I welcome the Minister’s announcement of the setting-up of the education scheme to tackle the ongoing attacks on Ambulance Service personnel.
I agree with the Minister that the Ambulance Service is an important part of the remit of the Department of Health, Social Services and Public Safety. She said that in most cases, the Ambulance Service fails to meet its targets in rural areas. The problem must be tackled urgently. The Minister highlighted the additional investment, which resulted in around 100 new vehicles and new equipment. Some £300,000 has been allocated to the dispatch system. I welcome that as a positive step forward, but I do not think that it is enough, even taking on board the constraints with which the Minister is faced. Everyone who has taken part in this debate has shown that there is a problem of underfunding.
I thank John Fee for ensuring that the motion reached the Floor of the House. I am pleased that there is general agreement that adequate funding is crucial to improving, not only ambulance response time, but the service as a whole. I hope that all parties will continue to support the Minister in her efforts to obtain adequate funding for the service.

Mr John Fee: I thank the Minister for taking time to come here today and for her fairly comprehensive overview of what is happening in the Ambulance Service. I also thank Members for taking part in the debate. We are all singing from the same hymn sheet, so I will not go over all the details that have been discussed.
The Minister talked about providing equitable healthcare for the whole community. That is basically what the debate is all about. Under various pieces of legislation we have made it illegal to discriminate on the grounds of age, gender, political or religious views, disability or sexual orientation. We should probably have written into the legislation that there must also be equity between rural and urban dwellers.
When I tried to make that point to a senior health board official, he insultingly and facetiously said that he supposed that I wanted an acute hospital in every village in south Armagh. My response is not publishable. However, the thrust of it was that I did not, but that if we could not have acute services on everyone’s doorsteps, we would have to rely on the people who provide the ambulance, GP and primary care services in those communities.
In my area, certain acute services have been removed from Daisy Hill Hospital and some hospital services have been closed in Armagh. GP out-of-hours schemes have been created that have reduced the number of GPs available at weekends and evenings. These schemes rely on the Ambulance Service as a back-up. In that context, the Executive as a whole must make the Ambulance Service a priority.
It is also for that reason that my Colleagues and I will not oppose the amendment — if it gets the Executive’s attention, so much the better.
There is a remarkable urgency about this, because a great deal of consultation is necessary, and the proposals and the implementation strategy must be tested against various models. Nonetheless, this issue should have priority over all others.
The Minister has said that this issue will be examined. As with the Fire Service and the Police Service, the Ambulance Service should be a discrete, stand-alone centrally funded emergency service, and the sooner we achieve that the better. I thank the Minister and Members for their attendance and comments.
Question
Main Question, as amended, put and agreed to
Resolved:
That this Assembly recognises the pressures on the Ambulance Service and calls on the Minister of Health, Social Services and Public Safety to address the inability of the service to meet published response times in rural areas and further calls on the Executive to provide sufficient funding to allow for the early implementation of the strategic review of ambulance services.
The sitting was suspended at 12.31 pm.
On resuming (Mr Deputy Speaker [Mr J Wilson] in the Chair) —
Motion made:
That the Assembly do now adjourn. — [Mr Deputy Speaker.]

Dangers of the Bangor to Belfast Road

Ms Jane Morrice: I want to thank you, Mr Deputy Speaker, for being able to have this debate today. I also want to thank the Minister in advance for his patience and for being here to listen to what is an important issue.
Exactly one year ago this month, a young woman, Orla Hewitt, lost her life in a horrific accident on the Belfast to Bangor road. It was a Friday evening. She was driving home from work on her own, and she was hit by a lorry crossing the carriageway. Her life was not the only one devastated that day. Her four-year-old daughter was left without a mother, and her parents, her partner, her family and her friends all have to suffer the terrible consequences of this for the rest of their lives. I had the privilege of knowing Orla, and this debate is by way of paying tribute to her and her family and all the other families who have lost loved ones in tragic circumstances on our roads. I want to do more than pay tribute. I want to use the mandate that I have been given to press for positive change to reduce the terrible toll of death and destruction on the roads.
The debate is about the Belfast to Bangor road, believed to be one of the most dangerous roads in the country. It is said that people are taking their lives in their hands when they use this road, and the figures I have gleaned recently bear this out — they are nothing short of shocking. Ten people have been killed on this 10-to-11-mile stretch of road over the past three years — yes, 10 people on this small stretch of road over the past three years. If those people had died as a result of paramilitary activity, there would be uproar. However, this is a different type of terror that stalks us, and it is just as shocking, just as horrific and just as devastating for the families of the victims. Some might argue that, given the high volume of traffic on this road — and the statistics show that something in the region of 39,000 vehicles per day use it, which certainly is high — relatively speaking, the number of fatalities is low. However, everyone will agree that one death is one too many.
The figures for the period 1998-99 to 2000-01 show that 270 people were injured on the Belfast to Bangor road, of whom 42 were seriously injured. Serious injuries can include brain damage, loss of limbs and other horrific outcomes that statistics cannot possibly describe. Over a three-year period 270 people were injured, that is, 90 people injured on this short stretch of road each year. I am sure the Minister and everyone will agree that this is totally unacceptable. The cost, in terms of human tragedy, is far too great to calculate, and the Minister has heard me on many occasions referring to the cost to the economy of the casualties and deaths from road accidents. However, if those calculations are correct with regard to emergency services, healthcare, loss of income and productivity, the cost of those killed or seriously injured on the A2 since 1998 must surely go into tens of millions of pounds. That is why I cannot accept as justification the excuse that traffic-calming engineering works to slow down the speed of traffic are too costly.
I paint a bleak picture. However, on the positive side, it does not have to be that way, because we have the power to change the situation. That is why a debate of this nature is valuable. The Assembly can channel the anger and frustration of families, road safety groups, local councillors who have campaigned for years for something to be done, road users who are sick and tired of facing those dangers daily, and the emergency services who have to witness and deal with those tragic events into a positive outcome. Devolved government gives us the power to do something. The road is dangerous; it must be made safe.
In preparation for the debate, I spoke to many people who are closely involved — the police, road safety campaigners, people who live and work in the area and people who use the road regularly. There is general agreement that one of the most dangerous parts of the road is the stretch between Ballyrobert — which is at the Crawfordsburn turn-off — and the entrance to Holywood.
The road is best described as a dual carriageway without the safeguards. It is a four-lane highway with nothing separating the traffic. Many Members have used that road on many occasions and are aware of the dangers. The lanes are far too narrow. The speed limit is 50 miles per hour, and a car can stop dead in the outside lane to turn right, whether it is going to or coming from Belfast.
It is sheer madness to allow that to continue; therefore, I am proposing several actions to make the road safe. First, a central crash barrier should be built to separate the lanes of traffic and to prevent people from turning right off the main highway. Secondly, the speed limit should be reduced to at least 40 miles per hour on the stretch between Ballyrobert and the outskirts of Holywood. Currently, the route runs down from a dual carriageway with a central reservation and a speed limit of 60 miles per hour into a road with a speed limit of 50 miles per hour and absolutely no safeguards between the oncoming flows of traffic.
There should also be more rigorous enforcement of the speed limits along the road. For example, new ideas and new legislation should be examined to allow fines to be used to pay for enforcement projects. I will go into that issue in more detail later. Better signage is also needed, and I suggest the use of the speed-reducing strips that are on many dual carriageways to reduce cars’ speeds as they come to an intersection. Those measures would be valuable in reducing the speed of traffic on the road.
There is no doubt that excessive speed is a major killer on the Bangor to Belfast Road. It is treated as a speedway, which is why new ways of policing speed limits must be examined. There is such a thing as a "netting- off" scheme, where revenue from fines is used to pay the cost of, for example, new high-tech speed camera schemes. That should be seriously considered, even as a pilot project, for this stretch of road. Apparently, the project has worked successfully in Nottinghamshire. We should try to adopt the best practice exemplified elsewhere in the United Kingdom, in these islands and in continental Europe.
There are many other dangerous points along the stretch of road, including the Rathgael junction on the outskirts of Bangor and the Croft Road junction at Holywood. Parking also poses problems. There are no parking restrictions whatsoever, or occasionally there is a double yellow line. A red line warning that parked cars will be towed away would be a valuable introduction. Time does not permit me to detail other aspects of that issue. I want to give other Colleagues a chance to speak their minds on the issue.
I have spoken about the actions that can be taken to reduce the number of people killed and seriously injured on the road. In my call to the Minister for progress, I am also sounding a serious warning. A time will come — and it already has come in the United States — when families of victims test through the courts whether the authorities have done enough to protect road users. We must be conscious of that. The time has come for an end to buck-passing between Departments; they must now augment the strategy and resources for road safety. Much more money is needed for road safety, whether for use by the Department of the Environment, the Department for Regional Development or the Police Service’s Traffic Branch. The time has come for action, and I am not just talking about the Bangor to Belfast road; I am talking about roads throughout the Province.
I spoke to a police inspector who said that there must be sea change in the culture that accepts that accidents are inevitable. No level of deaths on the roads is acceptable. Zero tolerance is imperative. The time has come for action so that no more families must bring flowers to the Bangor to Belfast road. I rest my case.

Mr Alan McFarland: I thank Ms Morrice for bringing the debate to the House. This is an opportunity to discuss a serious problem in north Down. The Bangor to Belfast road has been in its present configuration for about 40 years.
I went to school in the area, and I can recall walking about a mile along that road to church on Sundays. At that stage it was a heavily used road, and it has remained in much the same state and configuration since then, with some modifications.
Traffic flow on the road has increased dramatically over the years. The ‘Family of Settlements’ document shows that Bangor has had a 20% increase in its population in the past 20 years, and since a majority of people in north Down work outside the area — many of them in Belfast — the traffic flow along that road has increased dramatically.
The road is dangerous. There are four lanes — two each way — closing at what can be a combined speed of 120 miles per hour. Although there is a 50 miles per hour speed limit on the road, most drivers tend to travel about 60 miles per hour and some even faster than that. There are high speeds and high volumes of traffic on a road designed 40 years ago for a much lower volume of traffic. Ms Morrice has already described one of the main difficulties on the road. On the stretch of road between Cultra and Craigavad there are a series of right turns, and some of those arrive as a surprise to the unwary driver because they have just driven over the brow of a hill. Unless drivers know the road, they can suddenly find that the traffic in front of them in the outside lane has stopped dead. Drivers try to cut in, and that leads to accidents.
Action of some sort must be taken to do away with the threat to life described by Ms Morrice. Some years ago I saw a plan for a new motorway on the Craigantlet side in the hills parallel to the road. The difficulty is that the price of land in Northern Ireland is so high that there is no possibility that the Department would be able to buy the land, let alone afford the money to build a motorway. There was another cunning plan to build a parallel motorway on the lough shore side. However, the cost of those motorways is clearly prohibitive, and it is unlikely that they will be built.
What can we do? One solution is to reduce the volume of cars. Colleagues in the House will be aware of the regional development strategy and of the regional transportation strategy currently being developed by the Department for Regional Development. They will also know from previous speeches made in the House that the Bangor railway line is being relaid and that it is to be hoped that there will be new trains on that line next year as a flagship for the way ahead in public transport. That will allow the Department to encourage commuters to leave their cars in a park-and-ride and travel to and from Belfast by train. If all goes well, that should reduce substantially the volume of traffic on the road. However, that will not do away with the problem.
Ms Morrice identified various actions, and I agree with most of them. Right turns must be banned, and that is something that can be done fairly easily. Some thought would have to be given as to how people who live on the opposite side of the road get home. One option would be to construct one or two new crossover bridges. That would be expensive, but traffic volume will increase in the future — although that could be reduced by public transport — so we must start looking 10 years ahead and construct those bridges to allow people to get back over the carriageway and have access to their homes.
The idea of an Armco barrier is attractive on the fast sections of the road, and provided that there are crossover areas, that could be managed. Clearly it is not suitable where people travelling away from Belfast need to get to the Craigantlet side. They must be able to get into their houses somehow. So that is perhaps a combination and a development of possible solutions.
It may be possible to introduce rush-hour speed limits. Experiments on the M25, where 60 miles per hour speed limits were introduced, showed that traffic travelling at a constant pace produced a much larger volume of traffic going safely through a given point at a particular time. There may be a case for introducing some form of rush-hour speed limit.
I oppose Ms Morrice’s contention that there should be low speed limits at all times on the Bangor to Belfast road. During the day, when there is a much lower volume of traffic, it would be unfair to interfere too much with the rights of the motorist to drive at a normal and sensible speed, provided that the right-turn risks are taken away. That would not be as much of a problem in such circumstances. Actions must be taken that would lead to a suitable compromise so that there is not too much interference during the day, but that deal with problems at difficult times.
I urge the Minister to re-examine the problems on the Bangor to Belfast road. Action must be taken now, because the projections and the problems will get worse unless there is a plan to deal with them.

Mr Kieran McCarthy: I shall speak briefly on the motion for two reasons. First, as a frequent user of the Bangor to Belfast road, I know the problems associated with it and the volume of traffic that it carries. Secondly, in the enforced absence of my party Colleague Mrs Eileen Bell, a Member for the constituency in which the road lies, we would not wish the voice of Alliance to go unheard by default.
Coming from the Ards Peninsula, I hope that I can be forgiven for comparing roads in my area with the Bangor to Belfast road and for saying, as gently as I can, that some people do not know when they are well off. The Bangor to Belfast road has been a major problem for many years. It was a problem in the days when the volume of traffic was but a small fraction of the present cavalry charge. Experts have often considered the problem, and alterations have been carried out as a result of their studies. The camber has been improved on some of the more dangerous bends. The road was widened slightly where it was possible to do so. A section of dual carriageway was built at the Bangor end of the road. However, the problems persist.
There are too many cars for too narrow a road. Speeding seems to be the norm, and unfortunately serious accidents are inevitable. Widening the road is not possible where it is most needed, and no amount of campaigning will overcome that fact. The entire Northern Ireland block grant would be needed to compensate the adjoining landowners for eating into their front gardens, never mind the cost of the construction. The Alliance Party would support any agreed solutions that would make road safety a priority in order to cut down on fatalities.
Perhaps the matter is being examined from the wrong angle. Should we not try to reduce the volume of traffic instead of trying to accommodate it? Should we not try to improve driving standards and to cut down speeding on the Bangor to Belfast road? Ms Morrice spoke about that issue.
I am glad that the Minister for Regional Development is with us today. I am sure that he will listen to what I have to say on this issue. Modest investment in the A20 from Portaferry to Newtownards would improve road safety on that road. The experts tell us, however, that many people in a similar situation will give up the use of their cars if they are provided with an acceptable, reliable and dependable form of public transport. We should seek to have improved bus and rail services that the public could have more confidence in, and which would surely stop many drivers from killing themselves and, indeed, killing or injuring others, through excessive speeding and lack of attention when using this very busy road.
Safer driving and a lighter volume of traffic would benefit everyone, and those goals are attainable. On behalf of my Colleague Eileen Bell, I fully support every effort being made by the Minister and the Department for Regional Development to provide a good safe passageway on this road, thereby saving lives.

Mr Norman Boyd: Although I am not a Member for the North Down constituency, I would like to make a few points, because I travel along the road regularly, having relatives in Bangor.
The dangers of the Belfast to Bangor road are well known. Many people use the road to travel to the north Down coast, which is a popular area for day trips, especially at Easter and during the summer months. However, the road is, sadly, only one of many in Northern Ireland that has accident black spots and many fatalities. My sympathy goes out to all those who have lost loved ones on our roads. However, in listening to the debate and what has been said about greater use of public transport, I think that there is some hypocrisy, given that most Assembly Members use cars. I take the point, but traffic volumes will not decrease — if anything, they will increase.
Unfortunately, the Patten Report on policing has had a detrimental effect on policing resources. Recently, there have been reports that the police traffic branch for the Greater Belfast area, which includes the Belfast to Bangor road, will be cut back. This decimation of police traffic branch resources will, sadly, almost certainly result in more accidents on the Belfast to Bangor road and on many other roads. Driving standards will deteriorate on all roads throughout Northern Ireland due to a lack of on-the-ground policing. We need adequate policing resources to police our roads properly and to catch those drivers who are intent on careless and reckless behaviour, and who endanger not only themselves and their passengers but also all road users.
The penalties for motoring offences are hopelessly inadequate, particularly for those who are guilty of causing death or serious injury. Several constituents who have lost loved ones have contacted me in the past few years, and I am sure that most Members have come into contact with relatives who have lost loved ones as a result of careless or reckless driving. Their pain is then compounded when those who are guilty of causing the deaths receive totally inadequate sentences. In some cases they receive only suspended sentences. Sentences must be tougher, and magistrates must be provided with the necessary legislation to deal with such offenders.
The proposer of the motion, Ms Morrice, is quite right in saying that the speed limit is too high on stretches of this road. However, the speed limit must be enforced to reduce the speed. The greatest deterrent is to have a visible police traffic branch presence on the road. I have travelled on the Belfast to Bangor road about six times in the past couple of months and, through no fault of the police, I have yet to see a police vehicle sitting by the roadside. Unfortunately, there will be more accidents and fatalities on that road, and elsewhere, unless more resources are put into the police traffic branch, rather than reducing its resources.

Mr Peter Robinson: First, I congratulate the Member for North Down, Ms Morrice, in securing an Adjournment debate on this subject. I thank her for raising the matter and for bringing it before the Assembly. It is a matter of considerable importance in its specific content and in the general issue that it raises.
I apologise to Ms Morrice, as my Colleague Sammy Wilson indicated that he would like to take part in the debate. I regret to inform the House that his mother passed away at lunchtime today. I am sure the House would like me to convey its condolences and sympathy to him and his family.
I assure the House that road safety is one of my Department’s top priorities. I am fully committed, along with the Roads Service and other agencies, to doing all that I can to reduce the number of people killed and injured on our roads. I assure the House that I take the views expressed seriously, as well as the suggestions that have been made. I will give an initial response to some of those issues; however, the Department will have to look at some of them, particularly at a technical level. I hope, in due course, to respond more fully to Members who have raised specific points.
I was aware that the timing of today’s debate was significant to the Member for North Down, Ms Morrice, as it is almost a year since her friend was tragically killed in an accident on the Belfast to Bangor road. I extend my condolences to the family and to Ms Morrice.
I was somewhat disappointed by the Member’s speech. It lacked one important ingredient: recognition that there are causes of accidents that have nothing to do with roads or the conditions thereof. That was rectified in the speeches of Mr McCarthy and Mr Boyd. I want to place on record, although I shall not comment on it as the matter is sub judice, that someone will be appearing in court as a result of the case that was the spur to Ms Morrice raising the issue, and there will be an attempt to prosecute for driving without due care and attention.
I have a different number for fatalities, although that is not the key issue — it depends on where one believes the Belfast to Bangor road starts and ends. However, of the six fatalities that I am aware of in the three years mentioned by the hon Member, every one was the fault of the driver of a vehicle. Inattention, diverted attention, excessive speed and driving without care are causing the accidents. People, not roads, cause accidents. That was missing from the hon Member’s speech. She said that "we have the power to change the situation" — if the "we" is the community as a whole, I agree, because it ultimately comes down to the people behind the wheel as to whether we can change it and the impact that we can have.
Taking the advice of the Member for North Down, Mr McFarland, I will speed up at this stage to place on record what the Roads Service has done on the Belfast to Bangor road. It is a main arterial route into Belfast, and it has a two-way traffic flow of almost 40,000 vehicles per day in some sections. Therefore, it is an important trunk road and commuter route.
Safety along that route is of particular concern. Therefore, the Roads Service has been active in carrying out several schemes, specifically directed at improving road safety, over the last year or so. I hope the House will allow me to outline some of these schemes, indicating the work undertaken.
First, high friction surfacing has been applied to almost all the signal-controlled junctions along the route, including the Sullivan Place and Shore Road junctions in Holywood, Tillysburn and, most recently, the Ballysallagh Road junction near Bangor. High level cantilever traffic signals were replaced, and additional signal heads on high poles have been provided at Cultra Station Road and Station Road, Craigavad. Safety improvements to prevent right- turning accidents have been undertaken at two junctions on the dual carriageway between Holywood and Belfast. Significant lengths of cycle track have been provided from Tillysburn to Holywood and from Ballygilbert to Springhill, near Bangor. We have resurfaced one and a half miles from Cootehall Road to Springhill, which has improved the skidding resistance of the road surface.
The urban traffic control system has been extended to cover 10 signalised junctions on the A2. The system continuously monitors the traffic signals for faults 24 hours a day, seven days a week. Maximum efficiency is ensured by altering the traffic signal timings to cater for the variety of traffic flows throughout the day. We have installed closed-circuit television cameras to monitor traffic flows at three additional junctions. The timings of traffic signals at Seahill junction were altered to create gaps in the traffic flow for the benefit of residents turning right at the nearby Larch Hill junction.
In January last year, we installed speed camera traffic signs along the entire route to support the police campaign of an increased level of speed enforcement on the road, in a bid to reduce the level of accidents.

Ms Jane Morrice: I was interested in the Minister’s remark that it is people, not roads, who cause accidents. He went on to list a host of actions carried out to make roads safer. Will the Minister not agree that safer roads can prevent accidents?

Mr Peter Robinson: There are steps that we can take and have taken, to control people’s behaviour and how they drive. I will address the specific issues raised by the hon Member. I also want to talk about some further safety improvements in the pipeline.
Roads Service officials have been developing a solution to the road accident problems at the junction of Rathgael Road and Old Belfast Road. That junction has the worst history of road accidents on the A2. The Roads Service has commissioned consultants to undertake a traffic study on the A2 Bangor ring road, Rathgael Road and Balloo Road. As a result of that study, junction improvements including the installation of traffic signals will be carried out in the forthcoming financial year, at a cost of £200,000. Roads Service also plans to resurface a section of road between Whinney Hill and Ballygrainey Road in the year 2002-03, at a cost of £600,000. That will contribute to road safety by maintaining good skidding resistance on the road surface.
For the longer term, as Members will be aware, my Department is developing a regional transportation strategy. Safety is one of the strategy’s five key objectives, with an estimated outcome of a reduction in accidents of 5% from the current level. During the discussion on the regional transportation strategy, the Member who tabled the Adjournment debate today missed the point that without the intervention contained in the strategy, accident rates would be expected to rise by 14% over the current level by the year 2012. We are planning for a reduction under the strategy.
The outworking of the regional transportation strategy will be through transport plans that will make more specific proposals for the actions illustrated in the strategy.
The Bangor corridor is being dealt with through the preparation of the Belfast Metropolitan Transport Plan. That work involves the consideration of transport corridors, including the Belfast to Bangor route. Investigations will be carried out, using a multi-modal-study approach and the resultant recommendations will include measures for improving public transport and the road network in the Greater Belfast area.
There is a truism in the Member from Strangford’s comments about paying more attention to getting people off the roads and into other modes of transport, rather than having to deal with the impact of greater traffic flows. The Belfast to Bangor route seems to be ideally placed for that, in light of the investment that is being made on the railway. There is a new station; new track is being laid; and new trains are coming onto that line. Undoubtedly, that improved service should attract people to use an alternative mode of transport. I hope that the Member will encourage her constituents to do so.
The basic argument that I have advanced is that the Department has provided a new, completely modernised station. I was there about a week ago. The Department is currently providing new track, and I hope that that will be completed soon. It has already set the contract for 23 new trains. I do not think that anyone could have expected the Department to progress so far in the short space of time since devolution.
That is not an immediate solution. However, if the hon Member wants an immediate solution, she has not provided any to the House today. The proposals that she has put forward will take even longer than what I have suggested.

Ms Jane Morrice: How long will it take to change the speed limit to 40 miles per hour?

Mr Jim Wilson: Order, order.

Mr Peter Robinson: It is not a case of simply throwing out a suggestion and believing that, automatically, because the figures on a pole along the Belfast to Bangor road are changed, that will make a difference to the behaviour of drivers. A reduction of the speed limit would not necessarily mean that there would be any driver improvement. By and large, drivers who cause accidents are not the ones who obey the speed limit restrictions on roads.
However, the proposed measures will be used to inform the statutory process — to develop the Belfast metropolitan area plan, which is being led by the Department of the Environment. The draft area plan is due for publication at the end of the year. I hope that I have demonstrated the Department’s promotion of improvements on the Belfast to Bangor road, particularly over the past year or so. I assure Members that I will continue to give high priority to road safety engineering in the future, on that route and on others, as far as is practical and affordable.
I want to deal with some of the specific issues that were raised during the debate. Ms Morrice made reference to erecting what she described as a "crash barrier" — which, I believe, departmental officials refer to as a "central safety fence". She may not be aware that any type of central safety fence or barrier must be set back from passing traffic by a certain minimum distance. The width of the barrier, together with the minimum distance required on both sides, amounts to a significant part of the central reserve — normally an absolute minimum of two metres.
That would require the removal of one of the four existing lanes, which would result in a catastrophic loss of capacity and severe congestion. Alternatively, the carriageway could be widened by the width of one lane, but reference has been made to the likely cost and disruption that would be caused by the acquisition process.

Ms Jane Morrice: What about the cost of the deaths?

Mr Peter Robinson: If the hon Lady would allow me to address the issue, I could then deal with the other matters that follow from it.
Apart from the cost, and the disruption that it will cause to her constituents in that area, the installation of a safety fence will impede private access along that part of the route. Unlike modern dual carriageways, there is insufficient space in which to do a U-turn at the next available public road junction.
2.45pm
Even if we were to contribute to the cost involved, using such a proposal to resolve some of the issues would give rise to a further safety hazard at another point along the road. Road engineers and safety experts must take account of the overall capacity of the road and the likely result of any measures they take.
Right turns were mentioned. One of the hon Lady’s Colleagues has been exercised about a right turn into the Culloden Hotel. My officials were willing to accompany her to speak to the hotel proprietors about the issue. From the Department’s point of view, having no right turn would encourage people to use the traffic lights a little further down the road. My officials are still willing to talk about it, but the hotel owners will have a strong view on it. If a right turn were banned, the hotel owners would appeal against it. The issue is not as simple as it might first appear.
A new road was suggested, and the cost difficulties of such a road were discussed. We are dealing with the regional transportation strategy and the area plans. Ultimately, the Assembly would have to fund such a route. If we looked for a track for such a road in the Craigavad/ Cultra area, there might be an objection or two, thereby prolonging the process. I hope that the rail network would have new trains running by the time that process would be completed.
Having given an off-the-cuff response to many of the issues that the hon Lady raised, I will consider them in more detail. I sympathise with the need to control speed. My personal belief is that it is an issue of enforcement. I told her Assembly Colleague so when she and my Colleague, the Member for South Belfast, discussed the Saintfield Road area with me.
One permanent speed camera will do more to reduce speed than many rumble strips and other features that my Department could implement. Ultimately, whether people feel that they can get away with breaking the speed limit determines how hard their foot goes on the pedal. I must agree with the Member for South Antrim that enforcement becomes a key issue. As a result of political exercises, the police do not have the manpower to put a car on the road to slow traffic on the Belfast to Bangor road, or on any other roads around the country.
I have driven many times in other parts of the United Kingdom. One difference in areas where there are great problems in enforcing speed limits, is that there are constant reminders of speed limits that drivers cannot ignore. Drivers may look at the road in front and not see the signs beside them, but large circles on the road reinforce the speed limit. I have asked my Department to consider that measure. While I think such measures might be useful in reinforcing the message, road and safety engineers might have other reasons to suggest that they are not advantageous and might do violence to the overall principle of road safety.
The House would be doing a grave disservice to the people of Northern Ireland, particularly those touched by tragedy of road accidents, if it perpetuated the myth that road accidents can be eliminated only by better roads. Any road safety professional, whether among traffic police, road safety educators, the Royal Society for the Prevention of Accidents (RoSPA) or highway safety engineers, will say that the best way of cutting accident numbers is for each road user — particularly drivers — to take a personal responsibility for using roads safely. Road users can do that by keeping to an appropriate speed, driving with due care and attention, using seat belts and following the adage "Don’t drink and drive".
Of course, my Department will do what it can to improve the sites where there are accident clusters and where steps can be taken to control drivers. It is right to do that, but it is not realistic to expect that highway engineering alone is the answer to the scourge of road accidents.
In conclusion, I am sure that the House will join me in supporting the police, who must enforce the road traffic laws, and in exhorting all road users to take personal responsibility for road safety.
Adjourned at 2.50 pm.